dr james c wittig, orthopedic oncologist, new york, new jersey
About Dr. Wittig
Adamantinoma

General Information

  • Primary intraosseous epithelial neoplasm
  • Low-grade malignancy and predilection for tibia
  • Associated with intraosseous fibro-osseous proliferation (osteofibrous dysplasia)
  • Classic vs. Differentiated
    • Classic – grow beyond cortex, older patients, sometimes metastasize
    • Differentiated – confined to cortex, earlier age, do not metastasize

Clinical Presentation

Signs/Symptoms:

  • pain & Swelling, painless swelling, or pain alone
  • 50% have history of localized trauma

Prevalence:

  • males and females affected equally

Age:

  • range 3-72 years old
  • ~50% present in second or third decade

Sites:

  • Predilection for tibia (90%)
  • favoring diaphyseal portion of bone

Radiographic Presentation

  • Sharply defined osteolytic defect (lobulated, multicystic, or “soap bubble”)
  • May be considerable perilesional sclerosis


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Gross Pathology

  • Sharp demarcation and lobulated configuration may be seen
  • Solid areas are soft to firm, gray or white, granular or fibrous
  • Cystic spaces and areas of intralesional hemorrhage are common
  • Length: 5 cm to entire shaft

Microscopic Pathology

  • Four histologic patterns:
    • spindled
    • basaloid
    • tubular
    • squamoid
  • Situated in a loose or dense fibrous stroma
  • May form tubular structures lined by one or two cells, which may branch and anastomose
  • Appear as small, vascular tubules with lumens in cross section
  • May have squamous differentiation
  • Nuclei are usually bland
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